Healthcare: Balance between Public and Private

Evolution of Indian Healthcare System:
  • On the eve of Independence, the founding principles of health care for India were established through the Bhore Committee.
  • Here, health care was envisaged as comprehensive, universal and free at the point of delivery, based on a government-led service, and to be paid from tax-funded revenues.
  • These policies, which were adopted from the National Health Service (NHS), a major social reform in the U.K. following the Second World War, have stood the test of time and remain a source of pride for the U.K.
  • But for India, it is an embarrassment that this health model has declined because of chaotic, mismanaged, unregulated and discriminatory policies and the priorities of successive governments.
  • This has created a second system (supposedly more efficient) in the form of the urban private sector, which is responsible for most health care in India.
  • The private sector over-medicalises: over-promises, over-investigates, over-treats and overcharges to meet management targets, creating needless fear and paranoia.
  • There has been a paradigm shift from a service to a fee-for-service model of health care.
  • Medicine has changed from ‘doctor-patient-treatment’ to ‘customer-provider-delivery’.
  • All this disorganisation has led to a trust deficit between patient and doctor.
  • The decline of a universal, social health system has led to the cost of treatment becoming astronomical.
  • Health care in India is changing from a conservative, clinical, affordable, accountable, patient-centric British model to a more investigative, aggressive, expensive, commercial and insurance-driven American system, without the safety mechanisms of either.
  • India still faces many communicable diseases (malaria, dengue and tuberculosis) which require a robust public health system.
  • Along with non-communicable diseases (diabetes, heart disease and cancer) also on the rise, this is a double burden.
  • This mismatch is further compounded with only 4% of GDP allocated to health.
  • India has one of the highest (86%) out-of-pocket (private) expenditures on health care in the world.
  • With little or no health insurance, this leads to approximately 40 million people falling below the poverty line every year.
  • Let’s draw an analogy with the organised, Western health system (public and private care), taking the example of any international university.
  • There are two kinds of fees — one for national students and usually a slightly higher one for international students, which is akin to treatment costs in a hospital where there are higher private fees.
  • At the end of the course, all students are awarded the same degree much like patients who get the same level of care in a public or private hospital in the West.
  • Private care in the West exists to streamline routine services and possibly reduce waiting times.
  • In an ideal world we would want an egalitarian health-care model.
  • However, misuse of private health care at the patient’s expense leads to a breakdown of the whole model.
  • Compare it to transport, where there are buses and taxis, representing public and private health care, respectively. An imbalance (with taxi overuse) can induce chaos.
Way forward
  • A balance between the two health systems is required, where there is no compromise made on the quality of care delivered.
  • Expensive treatments and interventions with marginal benefits should be realistically considered to treat frail, futile, terminal patients and relatives should be explained the outcomes.
  • It is for the society to decide the ceiling of treatment.
  • We need to strengthen our public health-care system based on the pillars of trust, accountability and efficiency.
  • A balance needs to be made between public and private health care.
  • This balance will only be restored by the mutual respect and belief between a doctor and patient.

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